PA hikes Workers Compensation rates after Protz Decision

The Pennsylvania Department of Insurance hiked the workers compensation insurance premium for the second time within a year.  The Department of Insurance already hiked rates 6.6% that went into effect on February 1, 2018.  This second hike will increase premiums by .7% to go into effect on April 1, 2018.

Both jumps follow a state Supreme Court ruling last summer invalidating a portion of the state’s workers’ comp law, a move that some expect to result in higher costs for employers.  The ruling barred the use of so-called impairment rating evaluations, or IREs. The evaluations allowed companies to cap costs for paying out wages lost due to injury, typically in cases where workers could not return to work.

Lawmakers have introduced legislation to restore use of IREs. But it has not moved.

Workers’ comp rates typically are adjusted once a year. But after the court ruling, the rating bureau took the rare step of asking for an interim increase, which is the 6.06 percent hike that took effect this month.

The Department of Insurance increased the rates twice within a year for the first time in 25 years due tot he PA Supreme Court’s Protz v. WCAB, which invalidated Impairment Rating (IRE) provisions of the PA Workers Compensation Act.  The IRE provision served as an avenue for Employers and Insurance Carriers to limit benefits.  You can read more about the Protz decision here.

In Pennsylvania Workers Compensation, what happens if my claim petition is not answered?

Over the past eight weeks, for some reason, I have had three different claim petitions filed on behalf in injured workers in which the employer and its insurance carrier failed to file a timely answer.  Kind of odd.  That is more than I have had in the prior two years.  So what happens then?

First, what is a timely answer?  Under the Pennsylvania Workers Compensation Act, an employer and insurance carrier has 20 days to answer a claim petition for the answer to be timely.    The statutory period for the 20 begins from the date of service by the Bureau (Department of Labor & Industry), which is nearly automatic now with the WCAIS (the state’s automated workers compensation adjudication system).  The Bureau notifies the parties via a Notice of Assignment that alters that parties to the Workers Compensation Judge assigned to the case.

So what happens if the employer fails to answer within 20 days?

What should happen is your attorney should make a motion called a “Yellow Freight Motion”.  The motion comes from the case of Yellow Freight Systems v. WCAB (Madara), 423 A. 2d 1125 (Pa. Cmwlth. 1981).  The court addressed this issue specifically.

In applying this Section, we must emphasize that the referee ruled that the employer’s failure to file its answer, within 15 days of being served with the claim petition, constituted an admission of the allegations in the petition. That decision was tantamount to a ruling that the employer had not shown an adequate excuse for not meeting the filing deadline fixed by Section 416, and therefore lost its right to file an answer at all.7 In short, the case was in a posture as if the employer had filed no answer.  Given that posture of the case, it became incumbent upon the referee to follow the procedure set by Section 416 where no answer has been filed: to decide the matter on the basis of the petition and evidence presented.8 The phrase “and evidence presented” must be construed to mean evidence presented by the petitioner. To construe the phrase to include evidence presented by the adverse party would negate the sanction for not filing an answer in accordance with the terms of the Section. That is, unless the phrase “and evidence presented” is restricted to evidence presented by the petitioner, the adverse party could refuse to file an answer and still come to the hearing and offer evidence in rebuttal or as an affirmative defense to the claim petition . . .  It is true that the general rules of pleading and civil procedure do not govern workmen’s compensation proceedings. However, Section 416 of the Workmen’s Compensation Act precludes evidence from an adverse party who has not filed an answer to a claim petition, in accordance with the terms of that Section, absent adequate excuse or dispensation.

So what does that mean?  It means that when an employer fails to file an answer within that statutory period without adequate excuse, every well-pleaded factual allegation in the claim petition is admitted as true and the employer is barred from presenting affirmative defenses and from challenging the factual allegations in the claim petition.   Since the Yellow Freight case, further case law has developed on lack of timely filed answer.    When a Claim Petition is alleging ongoing disability, meaning the injured worker remains out of work, a rebuttable presumption exists.  Essentially, the employer can present rebutting to try an overcome the presumption of ongoing disability. (Chik-Fil-A v. WCAB (Mollick), 792 A.2d 678 (Pa. Cmwlth. 2002).

Moreover, while Employer is barred from asserting affirmative defenses to the allegations contained in Claimant’s claim petition, Claimant is only entitled to a rebuttable presumption that her disability continues after the last date that Employer should have filed an answer. Heraeus. Employer is not barred, therefore, from presenting evidence itself, or attempting to discredit the Claimant’s evidence, to rebut the presumption that Claimant’s disability continues into the indefinite future. Id.

So the fight over ongoing disability could continue.  Certainly make the defense of the claim harder for the employer, the claimant can get paid benefits, but the case is not over.

The fact is, workers compensation law is quite complex.  If you have been injured at work, call Mooney & Associates today for a FREE consultation.  We represent injured workers throughout Pennsylvania and have 16 office scattered throughout Central Pennsylvania from Chambersburg east to Lancaster, and from the Maryland line north to Lebanon.  Call today at 717-200-HELP.

Worker killed at Manitowoc in Shady Grove, PA

A crane accident at the Manitowoc plant in Shady Grove, PA has killed a workers and injured several others.   The accident occurred today at around 830 AM.

“There’s definitely a serious accident with a fatality involved. That’s all I can tell you at this time,” Warner said around 9:30 this morning.

The Franklin County Coroner and Pennsylvania State Police were called to the scene on the Manitowoc property that fronts Route 16 in Shady Grove, between Greencastle and Waynesboro.

Manitowoc manufactures crane in Shady Grove, Pennsylvania, formerly known as Grove Manufacturing.  In 2016, Manitowoc announced it would be closing its manufacturing operations in Manitowoc, eliminating 528 positions. Work from the facility moved to operations in Shady Grove, Pennsylvania. The Shady Grove operation employees between 800 and 900 employees.

Death on the job have been rising in recent years.  In 2013, OSHA reported 3,635 deaths on the job.  That rose to 3,728 in 2014, then to 3,751 in 2015, and 4,098 in 2016.

In Pennsylvania,  widows and children of injured workers are entitled to workers compensation death benefits.  It can be a complicated issue and the litigation that could result from the death of an injured worker can be quite complex.   At Mooney & Associates, we have a full workers compensation litigation practice.  We operate 16 offices throughout Central Pennsylvania.  Injured workers are entitled to a FREE consultation with us and can call 717-200-HELP or 1-877-632-4656.

Carlisle man wins workers compensation benefits despite prior injury

Recently, I have done several posts on pre-existing conditions and work injuries.  I’ve done so because pre-existing conditions are a common thread in many workers compensation denials.  However, again, the fact a pre-existing condition exists IS NOT a bar to workers compensation benefits when an injury occurs on the job.

I recently won workers compensation benefits for a Carlisle area truck driver.  My client was injured while loading product on a truck.  He injured his shoulder.  His employer and the workers compensation insurance carrier denied him benefits because he had a previous shoulder injury at another job that resulted in a partial shoulder replacement.  In fact, he had just settled his first work injury claim five months prior to this injury.

We were able to convince the Workers Compensation Judge that he fully recovered from his prior injury, that he had moved on to a new job and had experienced no shoulder problems, and that the new injury, changed the condition of his shoulder which caused him to be unable to work.  Eventually, he had his partial shoulder replacement converted to a total shoulder replacement.   By winning his case and having his claim petition granted, my client will and has received wage loss benefits back to the date of injury and ongoing, and that his medical bills, including the cost of the total shoulder replacement surgery, are to be paid by the workers compensation insurance carrier.

The important point here is this — if you have a pre-existing condition, if you had a prior injury — and you experience a new work injury which is then denied, you can fight and win benefits.  Call Mooney & Associates today for a FREE CONSULTATION to discuss your case.  We have 16 offices scattered throughout Central Pennsylvania, for your convenience.  Call us at 717-200-HELP or 1-877-632-4656.

 

2018 Pennsylvania Average Weekly Wage rates released

The Pennsylvania Department of Labor and Industry has released it’s 2018 average weekly wage rates.  Your average weekly wage determines your corresponding compensation rate, the rate your would be paid each week if you were out of work for your work injury.  I recently published an article on our official Blog at Mooney & Associates.  You can see the blog post here for the new rates.

Ensuring your average weekly wage rate is calculated properly is critical to your case.  Here is why.

It is absolutely critical that your wages are calculated correctly. A small error in calculating your average weekly wage can have a significant financial impact in your case. For instance, let’s assume an individual gets hurt at work in 2018 and his wages are calculated to be $500.00 per week (AWW). That would provide a weekly disability compensation rate of 90% of $500.00 per week, which would make the compensation rate to be $450.00 per week. If your employer accepted your work injury, that is what you would receive per week while out of work. Now, say that you settle your claim for two years of disability. That would provide you a settlement of $46,800.00. Now, let’s assume that your AWW was calculated incorrectly, the insurance carrier had wrong wage information or forgot bonuses. Let’s assume then your AWW should have been $550.00 per week, instead of $500.00 per week. At $550.00 per week, your weekly disability rate would be $495.00 per week, instead of $450.00 per week. A two year settlement at $495.00 per week would be $51.480.00. When you settle your case, that is a $4,680.00 mistake. A correct calculation would be an additional $4680.00 in your pocket. Think about that. That is only a $40.00 per week mistake. That is why ensuring your AWW is calculated correctly is absolutely critical to you.

This is just another example of why treading through a workers compensation case on your own is a dangerous venture.  Getting expert advice will ensure your wage are calculated correctly, that you do not sign forms from the insurance carrier that you should not sign, that you get the medical treatment you need, and that you get the benefits the Act provides and that you deserve.  Insurance companies have their defense counsel reviewing your case, shouldn’t you be protected on your end?  Call Mooney & Associates today at 717-200-HELP or toll free at 1-877-632-4656 for a FREE CONSULTATION.

Warehouse growth expected to continue growing in Chambersburg, Shippensburg, and Carlisle

Growth in warehouse development and subsequent jobs that follow are expected to continue to grow in the Chambersburg, Shippensburg, and Carlisle areas of South Central Pennsylvania, in 2018.   It is kind of obvious given the continued development underway.

Looking at Shippensburg, you can see warehouse development currently underway off Interstate 81 Exit 24.  There is expected to be an additional warehouse to be built after the one behind the new Sheetz Store is completed.  The warehouses being developed off Exit 24 are considered to be Spec Warehouses.    Specifically, Spec Warehouses are built to be leased out, meaning, it is not being built for a specific company, such as Procter & Gamble on the Olde Scotland Road or Georgia Pacific off Exit 29 in Shippensburg.  Additionally, there is expected to be continues development off Exit 29 in Cumberland County by the Beistle Company and Georgia Pacific locations.

Just a bit North on Interstate 81. you will witness an ongoing boom in warehouse construction in Carlisle.  Many of these huge warehouses that are being erected are again, Spec Warehouses, being developed to lease.  Currently, you can see warehouse development continuing to boom off Exit 44, the Allen Street exit.  This all goes along with the booming construction in Chambersburg off Interstate 81.  The booming distribution economy along the Interstate 81 corridor is causing low unemployment rates in Franklin and Cumberland Counties.  Many of these jobs are either temporary employment or temporary to start before being hired on full-time by employers.

Warehouses jobs, such as order selectors, fork lift drivers, loaders, and more, are at risk for work injuries.  You can view the actual phamplet from OSHA on the most common injuries int he warehousing industry.   I also published an article here on the most common warehouse injuries that walk into my office.

Here are a few pointers for injured warehouse employees.

First, know who your employer really is.  Let me explain.  If you work at Procter & Gamble in Shippensburg and are specifically hired by a temporary agency, your employer for workers compensation purposes, is the actual temporary agency you work for, NOT Procter & Gamble.   It is important to identify the proper employer in a workers compensation case.

Second, notice of injury is critical.  Always remember to report your injury immediately to a supervisor.  If you work for a temporary agency, you must also report the injury to the agency, not just a floor supervisor.  Failure to report an injury right away almost always leads to a denial of your claim.

Third, be careful what you sign.  Employers tend to put a ton of paperwork in front of an injured worker.  Before signing it, make sure you understand exactly what you are signing and what is means to your rights.  Call us right away if you have question on what you are signing.  We always offer FREE consultations for worker injuries.

Fourth, seek immediate medical treatment.  Sometimes, I hear stories of injured workers who just try and ‘grunt’ through pain. They think the injury will just go away.  Then it doesn’t.  That lack of medical treatment in the beginning can trigger a denial of your claim as well.  Second, ‘grunting’ through an injury can worsen an injury.  Sometimes we see that in partial rotator cuff tears that end up being full thick tears.  There is a substantial difference in terms of need for surgery and recovery.   Don’t risk it.  Get checked out.

Fifth, ask your employer if they have a panel list of medical providers.  They are required to in order for the 90 day panel provisions to be in effect.  Second, if they do have a list, you are FREE to treat with any provider on that list.  Your employer can’t dictate which one you treat with.

Finally, ask your employer for a work injury incident report.  Keep notes on employer responses.

Workers Compensation is a complex area of law.   If you are hurt at work, call Mooney & Associates right away for a FREE consultation with me.  Your rights and benefits under the Workers Compensation Act are too valuable to risk.  At Mooney & Associates, I have litigated hundreds of cases.  I have deposed tons of doctors.  I have recovered millions of dollars for injured workers.  I stand ready to fight and protect your benefits.  Call today at 717-200-HELP or 1-877-632-4656.    If you prefer, you can also email me right here through this site.  We have offices throughout Franklin, Adams, Cumberland, Dauphin, Perry, Lancaster, Lebanon, and York counties In Pennsylvania.  I will meet you at the office most convenient for you.

 

Our Top 5 Pennsylvania Workers Comp Posts for 2017

As we sit at the doorstep to 2018, I want to provide you the top five posts from my blog this year in Workers Compensation.  These posts I chose due to traffic and due to the information we provide to injured workers across Pennsylvania.  If you missed them, well, link to them here.

Unfortunately for me, often times I am meeting a new client, it is because they are in pain and have suffered a significant injury on the job.  I can certainly say, I spend all efforts necessary to protect my client’s rights and benefits under the PA Workers Compensation Act, and fight hard to get my clients a fair and reasonable settlement.  Besides the legal aspect of the cases, I have met a lot of good people in 2017 that work hard, very hard.  They do not want to be out of work.  They do not want to be in pain.  They do not necessarily want a settlement and have to resign their job.  They are not taking advantage of medicine or the ‘system’.  They simply want to get better and get back to work.  Unfortunately, many times, they are not able to go back to the job they were hurt at due to limitations.   So that is my rant to end 2017 — before judging an injured worker, think about it.  I’m not real certain you would want to walk in their shoes.

That being said, here are our Top Five Pennsylvania Workers Compensation posts of 2017

1. Pennsylvania Supreme Court strikes down IRE provisions in Workers Compensation Act

In 2017. the Pennsylvania Supreme Court handed down a landmark decision in the Pennsylvania Workers Compensation world.  The Court struck down the Impairment Rating Provisions of the Act, which served as an avenue to limit an injured workers benefits.  Read the article and protect your rights.

2.  In Pennsylvania, Preexisting conditions are not a bar for workers compensation benefits

This article dives in pre-existing conditions.  Often times, an injured worker may have a previous injury at the same location, arthritis, etc… They are also told by employers across Pennsylvania that they can’t file a claim because the condition is pre-existing.  WRONG!  Read the article and protect your rights.

3.  Injury Description is important in Workers Compensation

Your work injury, even if accepted, is usually just accepted as either a strain/sprain or a contusion.  The description of injury can lead to medical treatment being denied.  Many workers compensation cases in Pennsylvania are litigated over this very thing, injury description.  Why?  Because medical treatment is expensive.  Read the article and protect your rights.

4. Understaffing at Pennsylvania Nursing Homes cause work injuries

It’s a common thread in many nursing home injuries that I see in Pennsylvania.  Injuries could have been avoided by more staffing, better automation, and better safety protocols.  Instead, the injured workers, like Certified Nursing Assistants (CNA), are the ones that pay the heavy price in cost cutting maneuvers.  Read the article and protect your rights.

5. Concussions aren’t just in sports, but in the workplace too

They don’t just happen in football.  They happen all too often in the workplace.  Not all recover from concussions at the same rate.  Read the article and protect your rights.

 

In Pennsylvania, Preexisting conditions are not a bar for workers compensation benefits

In Pennsylvania, if you have a pre-existing condition and get hurt at work, you may still be eligible for workers compensation benefits.  Often, injured workers are advised by their employer that they can’t file for workers compensation benefits because they had a pre-existing condition.  That is wrong.  Period.

It is long standing law in Pennsylvania that an aggravation or exacerbation of a pre-existing condition can be a compensable work injury.

An aggravation of a pre-existing degenerative condition constitutes a compensable work injury. SKF USA, Inc. v. Workers’ Compensation Appeal Board (Smalls), 728 A.2d 385, 387 (Pa. Cmwlth. 1999).
To establish a compensable aggravation“the medical evidence [must] establish that the injury materially contributed to the disability rather than the disability resulted from the natural progress [ion] of a pre-existing condition.” Miller v. Workmen’s Compensation Appeal Board (Pocono Hospital) , 539 A.2d 18, 20-21 (Pa. Cmwlth. 1988) (citing Halaski v. Hilton Hotel, 409 A.2d 367 (Pa. 1979)). Whether an incident has materially contributed to the disabling injury “is a question of fact to be determined by the WCJ.” SKF, 728
A.2d at 388.
As you can see, it is well established law.  The litigation involving pre-existing conditions is quite complex.  It goes beyond just proving aggravation, but also that the aggravation is ongoing.  It will take significant lay and medical testimony.  It is critical to have a proven and experienced workers compensation attorney that understands medical evidence.  At Mooney & Associates  we have the experience and the results to prove it.
Usually when we are talking about pre-existing conditions, we frequently see conditions involving the back, knee, and shoulder.  Let me use some of my cases as examples.
Pre-existing Knee Arthritis
I had a case of an injured worker that involved  pre-existing arthritis in her knee.  She is a senior citizen.  She worked full-time for a national retailer.  Four years prior to the work injury, she had treated for knee arthritis pain, including a few injections, but had not treated in the three preceding years.  After she slipped and fell at work, she could not put weight on her knee and was unable to work.  She underwent conservative treatment regiments, such as inflammatory and pain medications, work restrictions, bracing, physical therapy, and additional injections, but all failed to relieve her symptoms.  Her doctor recommended a total knee replacement, due to the extensive arthritis in her knee.  We were unable to settle the case because of the recommendation for and need for a total knee replacement.   We went to decision and won on the merits.  The WCJ granted the claim petition and had to pay my client’s wages while out of work as well as the expenses of a total knee replacement.  She is still currently being paid wage loss benefits.
Pre-existing shoulder
Have a client that worked for the same employer for over 25 years.  He slipped and fell at work and injured his right shoulder.  After an MRI was completed, the insurance carrier denied benefits due to pre-existing right shoulder rotator cuff tears.  The tears were pre-existing, we conceded that.  It was clear by looking at the MRI that the tears were chronic, not acute.  Additionally, during medical testimony, the treating orthopedic surgeon also testified that the tears were degenerative and pre-existing.  However, the doctor also testified that his chronic tears were not symptomatic, and but for the fall, he would have remained non-symptomatic.  Prior to the fall, he never experienced any shoulder pain.  This is not all that uncommon. This gentleman never treated for shoulder pain.   Never even missed a day of work.  He had no idea or no way of knowing he had pre-existing tears.  We eventually won the litigation, the claim petition was granted, and the insurance carrier had to pay wage loss benefits, and still are today, and pay for a total shoulder replacement.  A simple rotator cuff repair could not be performed because of the extensiveness of the tears.
Pre-existing Back
I had a client that had a prior work injury from a different employer that included a low back fusion surgery in 2007.  He recovered from that surgery and had not sought low back treatment since 2008 except for an updated MRI in 2011.   My client injured his low back with a new employer in 2014,  while working at a road construction site.  Given his prior low back surgery, the insurance carrier denied his claim. I positioned his claim well through an extensive medical record review, treating back surgeon’s deposition testimony, and our clients’ testimony on his recovery from his prior injury.   Right after briefs were drafted, but before the decision was issued, we were able to secure a nice lump sum settlement for our client, plus payment and reimbursement of all outstanding medical bills related to his new low back injury.
These are just a few of many examples of cases in which I have either gone to decision or settled claims involving pre-existing conditions.  They are complex.  They involve critical medical testimony.  That’s why it is vital that if you are injured at work and believe you aggravated a pre-existing condition, that you seek an experienced and proven workers compensation attorney to handle your claim.  Don’t let your employer tell you that you can’t get benefits because you had a prior condition.   We have been in the trenches, have won these  types of cases, and settled many others like these.  We certainly aren’t hesitant to go to decision either.
Call Mooney & Associates today for a FREE consultation regarding your work injury.  We have 15 offices throughout Central Pennsylvania.  I will meet with you at the offices nearest to you.  Call today at 717-200-HELP or 1-877-632-4656.  You can also email me at mab@mooney4law.com.

Injured Workers Should Be Aware of Settlement Offers

It is that time.  With 2018 on the horizon, businesses are trying to get some loose ends tied up before the calendar turns.  Workers compensation insurance carriers are the same way.   They like to close out as many claims as possible to not carry them into the next year.  That means you may get an offer to settle your workers compensation claim.

My advice — exercise caution.  Call Mooney & Associates for a FREE consultation before setting your workers compensation claim.  Why?

1.  Are you ready to settle your claim, medically speaking.  Are you done with surgeries?  Do you need additional injections?  Are you getting better?  Are you going to have permanent work restrictions?  What are your costs for future medical treatment?  These are all very important questions that need to be discussed and thought through and can impact both the feasibility  of settlement and value of your case.

2.  Is it fair?  Most times, what an insurance carrier is going to offer you, is below what is really the settlement value of your case.   Listen, their number one concern is to get out of each claim as cheaply as possible.  You and your future are not their concern.  Our concern is you and ensuring you are getting the fairest settlement possible.  We will work hard to maximize your settlement value.  Every injury is different.  Every story is different.  Every carrier is different.  Every employer is different.  There are a ton of factors that go into what is ‘fair and reasonable’ and that is why it is absolutely paramount for you to get expertise advice form an experienced workers compensation professional.

3.  Are there other issues going on in your case?  What are your future medical costs?  Do you have outstanding medical bills not being paid by the insurance carrier?  Did you pay for prescriptions or doctor visits and paid out of your pocket?  Is there a subrogation lien with your health insurance?  Is there a subrogation lien from Medicare or Medicaid?  Are there any applicable offsets?  These issues can get quite complex.

4.  Is it the right time?  This is the most important question when settling your claim.  It may not be the right time for you.  We will sit down with you, listen to your concerns, become familiar with your claim, then provide our advice.  I have advised hundreds of clients to NOT settle at a particular time.  It is a very important and personal decision and we take that time to discuss it with you.  What about social security disability?  Should I apply before settling or after settling?  Am I eligible for social security disability?  Is it an option for me?  Will I have to resign from my job?

5.  Remember, it is final.  In most circumstances, when an insurance carrier settles a claim, it is completely settled.   What does that mean?  It means your entitlement to wage loss benefits and any future medical benefits ends completely.  Any future medical costs for your work injury becomes your sole and exclusive responsibility.  That is precisely why it is such an important decision.  Just because you settle does not mean your private health insurance, Medicare, or Medicaid will pick up your costs related to your work injury.    There are hybrid type settlements that fully leave medicals open or leave medicals open for a limited purpose, but they are certainly the minority type of settlement in workers compensation.  Given the significant impact that settlement has on your rights under the Pennsylvania Workers Compensation Act, speaking with an experienced workers compensation attorney is a no-brainer.

Mooney & Associates had fifteen office locations through Central Pennsylvania.  We can meet you at the location closest to you.  We have full staffed offices, open Monday through Friday, in Chambersburg, Shippensburg, Carlisle, Harrisburg, York, Gettysburg, and Hanover.  Additionally, not only can we handle Pennsylvania workers compensation cases, but we can also handle Maryland Workers Compensation cases.

Call today for a FREE consultation at 171-200-HELP or 1-877-632-4656.  You can also email me directly at mab@mooney4law.com.  Visit us on the web at http://www.mooney4law.com.

 

Injury Description is important in Workers Compensation

Pennsylvania Workers CompOne of the more important, and often overlooked, aspects of a workers compensation claim in Pennsylvania is the description of injury.  More times than not, if you get hurt at work and your employer accepts your work injury, the description of your injury provided is nothing more than a ‘strain/sprain’ or ‘contusion’, whether it be to your neck, back, shoulder, etc. . .  Often times, it is simply not accurate.

So why is that the description provided on the PA Department of Labor & Industry forms that you get?  Could be a few reasons.  First, many insurance carries only accept sprain/strains and contusions.  Second, your actual injury may have just happened and the actual medical diagnosis is unclear.  Third, it may actually be accurate.

More than likely, the first two reasons are applicable.  Many insurance carriers do not accept anything outside those generalized descriptions.  There is a reason for that.  By accepting only generalized descriptions of injury like a strain/sprain, it provides the insurance carrier leeway in denying future medical treatment.  For example, if you have an accepted left shoulder strain, but you recently had a left shoulder MRI that indicated a rotator cuff tear, the insurance carrier may deny surgery.  They will deny surgery based on the fact that they only ever accepted a left shoulder strain/sprain, not a rotator cuff tear.    Another frequent example is a head injury.  Often times, the accepted injury for a head injury is a ‘head contusion’.  That provides leeway for the insurance carrier to deny treatment for concussion and post concussion syndrome.  They often do as well.    Continue reading